Preventing a tragedy for seniors at the wheel

Sometimes the best judge of whether someone's still capable of driving safely is the passenger.

When my dad's driving deteriorated, I called the California Department of Motor Vehicles and asked about the procedure for having his license revoked. I could fill out a form, I was told, and my dad would be called in to have his driving ability reevaluated.

I thought about it, but did nothing. My brother said we should remove the carburetor and tell our father the car was kaput, but we never did that either.

If you've been in this situation, you know the dance. My dad insisted he was driving just fine, but the evidence was not on his side. One-way signs became invisible, lane markers faded, speed and distance were wild guesses.

If we took away his keys, as my mother pointed out, we'd be stealing his last bit of independence and making him miserable. If we didn't, and he hurt himself or someone else, we'd be responsible.

My dad eventually got so sick that the driving issue was moot, and when he died in February, he hadn't driven in months. But still, I should have taken charge a couple of years earlier, and I'll always regret being so irresponsible. When loved ones get old, sometimes you have to take action, and judging by my mail lately, no one finds it easy.

"Ten years from now, this is going to be happening in epidemic proportions," said Craig Power, whose 90-year-old father died from injuries suffered in a 2010 car accident in Orange County. The car was driven by his father's 85-year-old girlfriend, who was being treated for dementia.

Power sued the driver's doctor for not reporting her to authorities, but a jury decided the physician had not violated state law. California requires doctors to notify county health officials about disorders "severe enough to impair a person's ability to operate a motor vehicle." The doctor in this case said he had reported other patients, but this particular patient wasn't disabled enough to report.

As the nation ages, this will come up more and more. We're expected to have 57 million drivers 65 and older by 2030, and while texting teenagers or drunk drivers may be more deadly behind the wheel, that's no reason to avoid dealing with a growing convoy of cognitive loss.

Some people have suggested that elderly drivers should be required to take driving tests at age 75 or older — in addition to the written tests and eye exams required after age 70 — rather than have their licenses automatically renewed. Recently, after I wrote about a 72-year-old legally blind doctor who had his license renewed by the DMV, I heard from readers saying they've been shocked to find that their parents' and friends' licenses were renewed into their 90s.

"A friend with early signs of dementia began calling me from her car and asking directions to places well-known to her," said Diane Portillo, of Redondo Beach, who notified her friend's doctor. The license was eventually revoked, but it took a couple of years.

"As a parish nurse and a hospice nurse, I am frequently asked how to stop 'Mom' or 'Dad' from driving," said Kate Reeves of the Idyllwild area. "Yes, the DMV can pull the license, but have you any idea how many folks drive with no driver's license? The only real solution is to remove the car (not just the keys)!"

Dr. Gene Dorio, who makes house calls to elderly folks in Santa Clarita, says he tries to be sensitive but honest in telling patients about the compromises that come with age. He said he's had patients using walkers who think they're going to keep driving forever, and relatives, afraid to disappoint or send their loved ones into deep states of depression haven't told them otherwise.

"People will go out there and end up driving through stop signs or on the wrong side of the road, or just getting lost," Dorio said. "Some of them, their reflexes are too slow. They can't get their foot from the accelerator to the brake fast enough, or they don't hear the sirens coming or the flashing lights."

Dr. Donald Iverson, a Eureka neurologist who has studied cognitive loss and its effect on driving, said it's not always easy to diagnose risk.

"We don't have a cut-and-dried answer as to whether a person with mild dementia is impaired or not," said Iverson, who found that 76% of people with mild dementia were able to pass on-road driving tests.

A person with dementia might be perfectly lucid at times, and one symptom of the disease is an inability to recognize that there's a problem, Iverson said. That's how my dad was, insisting the real danger on the road was all the other drivers.

Iverson said the person in the best position to determine if a driver is impaired is the passenger, whether it's a relative or caretaker. And statistically, he said, when drivers voluntarily reduce the number of miles they drive regularly, or stop driving at night or when it rains, they've entered a phase in which they have a five-fold increase in the risk of crashes.

A good list of warning signs for unsafe driving — does the person drive too fast or too slow, straddle lanes, seem nervous or oblivious — can be found at http://www.la4seniors.com.

No doubt, doctors can do a better job of starting the conversation, and more testing after a certain age could help, too. But when you find yourself in a position to do what's necessary and potentially save lives in the process, I hope you're better at stepping up to that responsibility than I was.

The last couple of years my dad drove, it was luck, and nothing more, that prevented a tragedy.